GI Cancers

Question 1

What are the 2 main histological types of oesophageal cancer?

Answer 1

Squamous cell carcinoma

Adenocarcinoma

Question 2

What is the difference between where squamous cell carcinoma’s and adenocarcinoma’s affect the oesophagus?

Answer 2

SCC - proximal 2/3

Adenocarcinoma - distal 1/3

Question 3

What are the risk factors for squamous cell carcinoma of the oesophagus?

Answer 3

Smoking
Alcohol
Strictures
Achalasia
HPV infection
Plummer-vinson

Question 4

What are the risk factors for adenocarcinoma of the oesophagus?

Answer 4

GORD
Barrett’s oesophagus
Obesity
Smoking

Question 5

How do oesophageal cancers present?

Answer 5

Often present late as 75% of oesophagus must be occluded before “food sticking” symptoms

Dysphagia - solid --> liquid
Weight loss and anorexia
Vomiting
Upper GI bleeds - anaemia, melaena
Painful swallowing (odynophagia)
Hoarse voice
Retrosternal pain

Question 6

How is oesophageal cancer staged?

Answer 6

TNM staging

Question 7

How are oesophageal cancers investigated?

Answer 7

Upper GI endoscopy with biopsy
CT CAP - staging
Endoscopic USS for assessing local tumour invasion

Question 8

How is oesophageal cancer managed?

Answer 8

Ivo-Lewis esophagectomy

Question 9

How is oesophageal cancer managed palliatively?

Answer 9

Stenting

Radio, chemo, brachytherapy, laset ablation, photodynamic therapy considered

Question 10

What is crucial to consider in patients with oesophageal cancer?

Answer 10

Nutrition through every stage as they are malnourished due to dysphagia

Question 11

What are the complications of an oesophagectomy?

Answer 11

!!Anastomotic leak = mediastinitis!! 
Pneumonia
Atelectasis
MI
AF
Recurrent laryngeal nerve damage

Question 12

Where in the world does gastric cancer have the highest incidence?

GORD and obesity are associated with which gastric cancer?

Answer 12

Highest in Eastern Asia

Carcinoma of cardia - incidence is rising

Question 13

What are common risk factors for gastric cancer?

Answer 13

H Pylori
Smoking
Blood group A
Pernicious anaemia 
Salty/spicy diet
Gastric adenomatous polyps

Question 14

What are the indications for 2 week wait biopsy for gastric cancer?

Answer 14

> 55 + dyspepsia

<55 + dyspepsia + another symptom/risk factor

Question 15

What other symptoms would indicate a 2 week wait biopsy for gastric cancer?

Answer 15

Anaemia

LFT changes

Question 16

What is the gold standard investigation for gastric cancer?

Answer 16

Endoscopy with biopsy

Then CT or endoscopic USS

Question 17

How is Gastric cancer staged?

Answer 17

TNM

Question 18

Where are most stomach cancers found?

Answer 18

50% pyloric
25% lesser curve
10% each fundus/body + cardia
5% greater curve

Question 19

What signs/symptoms may a patient with gastric cancer present with?

Answer 19

Dyspepsia
N&V
Weight loss, anorexia, early satiety
Dysphagia

Anaemia
Virchow’s and Sister Mary Josephs Node
Jaundice
Palpable mass

Question 20

How are gastric cancers managed?

Answer 20

Gastrectomy + lymphadenectomy + chemo

Question 21

What are the possible complications of gastrectomy?

Answer 21

Splenic/short gastric vessel tear
Anastomotic leak
Anaemia 
Dumping syndrome
Impaired fat absorption
Osteomalacia
Osteoporosis

Question 22

How is gastric cancer managed palliatively?

Answer 22

Chemo
Surgical intervention, stenting, endoscopic dilation for obstruction
Blood transfusion –> anaemia
Corticosteroids –> anorexia

Question 23

On auscultation of the stomach in a distal gastric cancer what might be heard?

Answer 23

Succession splash - slooshing noise indicating gastric outlet obstruction

Question 24

What does GIST stand for and what type of tumours are they?

Answer 24

gastrointestinal stromal tumour

They are soft tissue sarcomas

Question 25

Where GISTs found?

Answer 25

Mostly stomach but also small and large bowel

Question 26

How does GISTs present?

Answer 26

Anaemia (due to GI bleed) Early satiety and bloating Fever, night sweats and weight loss

Question 27

How are GISTs managed? (Investigations and treatments)

Answer 27

``` Do not biopsy as risk of seeding Give Imatinib (tyrosine kinase inhibitor) ```

Question 28

What is the histology of pancreatic cancers? Where are they found most commonly?

Answer 28

Adenocarcinomas | Head of the pancreas

Question 29

What are the risk factors for developing pancreatic cancer?

Answer 29

Chronic pancreatitis Smoking Diabetes HNPCC, MEN, BRCA2, KRAS

Question 30

How may pancreatic cancer present?

Answer 30

Painless jaundice Pruritis Atypical back pain/epigastric pain Weight loss Failing endocrine: diabetes Failing exocrine: steatorrhea

Question 31

What is Courvoisers law?

Answer 31

A palpable gallbladder is unlikely to be due to gallstones in a painless jaundice picture

Question 32

How is pancreatic cancer investigated? (Key blood results and imaging)

Answer 32

Cholestatic LFTs High resolution CT: double duct sign (dilation of common bile and pancreatic ducts)

Question 33

What is the surgical management of pancreatic cancer? What are complications of this?

Answer 33

Whipples - dumping syndrome - peptic ulcer disease

Question 34

What is the palliative management of pancreatic cancer?

Answer 34

Stents | ERCP

Question 35

What are the complications of a gastroscopy?

Answer 35

sore throat aspiration pneumonia perforation

Question 36

What are the complications of a colonoscopy?

Answer 36

rectal bleeding infection perforation